Evaluation of pancytopenia

Diseases

Summary

Pancytopenia is a reduction in the number of red blood cells, white blood cells, and platelets in the peripheral blood below the lower limits of the age-adjusted normal range for healthy people. It is therefore the combination of anemia, leukopenia, and thrombocytopenia.

Pancytopenia may result from decreased production of blood cells due to bone marrow failure, or from immune-mediated destruction of blood cells, or non-immune-mediated sequestration in the periphery/spleen.

The diagnosis of pancytopenia is made from the results of an automated complete blood count and examination of the peripheral smear but, as the etiology of pancytopenia varies significantly, a detailed diagnostic evaluation is required in every instance.

Library

Table of etiologies for pancytopenia (SLE: systemic lupus erythematosus, CMV: cytomegalovirus, EBV: Epstein-Barr virus, GVHD: graft-versus-host disease)
Hypoplastic myelodysplastic syndrome with dysplastic normoblasts
Aplastic anemia: normocellular bone marrow is shown on the left; and empty marrow, typical of congenital or acquired aplastic anemia, is shown on the right
Flow diagram for evaluation of pancytopenia. Abbreviations: PNH, paroxysmal nocturnal hemoglobinuria; IBMFS, inherited bone marrow failure syndromes
Icterus or jaundice
Angular cheilitis
Gingival enlargement, petechiae and bleeding in acute myeloid leukemia
Clubbing of nails showing loss of the classic Lovibond angle
Café au lait spots on the back of a young boy

Citations

Key Articles

Kulasekararaj A, Cavenagh J, Dokal I, et al. Guidelines for the diagnosis and management of adult aplastic anaemia: a British Society for Haematology guideline. Br J Haematol. 2024 Mar;204(3):784-804.[Abstract][Full Text]
Young NS. Aplastic anemia. N Engl J Med. 2018 Oct 25;379(17):1643-56.[Abstract][Full Text]
Williams DA, Bennett C, Bertuch A, et al. Diagnosis and treatment of pediatric acquired aplastic anemia (AAA): an initial survey of the North American Pediatric Aplastic Anemia Consortium (NAPAAC). Pediatr Blood Cancer. 2014 May;61(5):869-74.[Abstract][Full Text]
Khoury JD, Solary E, Abla O, et al. The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: myeloid and histiocytic/dendritic neoplasms. Leukemia. 2022 Jul;36(7):1703-19.[Abstract][Full Text]

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